CMS/EIP Fiscal Report              Center: 53 
Services beginning 07/01/2019 ending 09/30/2019                Date of Report:11/04/2019   Page:   1
            List order: No List
    Payclass Filters:OTHER    
    Eligibility Filter:Not Part C
 
 
Services                                              Number of            Number of    Fee Reported          Avg Fee
                                                      Children             Units                              Per/Unit
 
  
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